Provider Demographics
NPI:1144225095
Name:DECARIA BROTHERS INC
Entity type:Organization
Organization Name:DECARIA BROTHERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DECARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-264-2230
Mailing Address - Street 1:1429 BURGETTSTOWN PLZ
Mailing Address - Street 2:
Mailing Address - City:BURGETTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15021-1187
Mailing Address - Country:US
Mailing Address - Phone:724-947-7000
Mailing Address - Fax:724-947-5699
Practice Address - Street 1:1429 BURGETTSTOWN PLZ
Practice Address - Street 2:
Practice Address - City:BURGETTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15021-1187
Practice Address - Country:US
Practice Address - Phone:724-947-7000
Practice Address - Fax:724-947-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413903L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152704OtherPK